Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$3.15

Service Code	NDC 63323-940-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.89
Rate for Payer: Aetna of CA Government/Medicare	$1.89
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.36
Rate for Payer: Cigna of CA HMO/PPO	$4.19
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$3.15

Service Code	NDC 63323-940-21
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.89
Rate for Payer: Aetna of CA Government/Medicare	$1.89
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Smart Auto/Commercial	$1.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.60
Rate for Payer: Aetna of CA Government/Medicare	$2.60
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.25

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-10
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cigna of CA HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.25

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-10
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.14
Rate for Payer: Aetna of CA Government/Medicare	$3.14
Rate for Payer: Cash Price	$2.36
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$2.62

Service Code	NDC 25021-316-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.10
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cigna of CA HMO/PPO	$2.10
Rate for Payer: Health Smart Auto/Commercial	$1.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.44
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.96

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cigna of CA HMO/PPO	$3.46
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.25

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.41

Service Code	NDC 70121-1576-7
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.25
Rate for Payer: Aetna of CA Government/Medicare	$3.25
Rate for Payer: Cash Price	$2.43
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-10
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.90
Rate for Payer: Aetna of CA Government/Medicare	$0.90
Rate for Payer: Cash Price	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$6.74

Service Code	NDC 0409-3375-14
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cigna of CA HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$3.15

Service Code	NDC 63323-940-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.52
Rate for Payer: Cash Price	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$2.52
Rate for Payer: Health Smart Auto/Commercial	$1.89
Rate for Payer: LLUH Dept of Risk Management WC	$1.73
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.36

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.20
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$1.20
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$1.50

Service Code	NDC 43066-997-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.90
Rate for Payer: Aetna of CA Government/Medicare	$0.90
Rate for Payer: Cash Price	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-10
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.60
Rate for Payer: Aetna of CA Government/Medicare	$2.60
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Smart Auto/Commercial	$2.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.60
Rate for Payer: LLUH Dept of Risk Management WC	$2.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.25

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.41

Service Code	NDC 70121-1576-1
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.06
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.25
Rate for Payer: Aetna of CA Government/Medicare	$3.25
Rate for Payer: Cash Price	$2.43
Rate for Payer: Health Smart Auto/Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.25
Rate for Payer: LLUH Dept of Risk Management WC	$2.98
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$6.74

Service Code	NDC 0409-3375-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cigna of CA HMO/PPO	$5.39
Rate for Payer: Health Smart Auto/Commercial	$4.04
Rate for Payer: LLUH Dept of Risk Management WC	$3.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$5.24

Service Code	NDC 67457-852-00
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.14
Rate for Payer: Aetna of CA Government/Medicare	$3.14
Rate for Payer: Cash Price	$2.36
Rate for Payer: Health Smart Auto/Commercial	$3.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.14
Rate for Payer: LLUH Dept of Risk Management WC	$2.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.93

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [121298]

Facility

$0.04

Service Code	NDC 9994-0814-06
Hospital Charge Code	NDC121298A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV [121298]

Facility

$0.04

Service Code	NDC 9994-0814-06
Hospital Charge Code	NDC121298A
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.03

NORETHINDRONE 0.5 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10741]

Facility

$0.93

Service Code	NDC 0555-9008-79
Hospital Charge Code	1710118
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.42
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70

NORETHINDRONE 0.5 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10741]

Facility

$0.93

Service Code	NDC 0555-9008-79
Hospital Charge Code	1710118
Hospital Revenue Code	259
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Cash Price	$0.42
Rate for Payer: Cigna of CA HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.70

NORETHINDRONE ACETATE 5 MG TABLET [10747]

Facility

$2.23

Service Code	NDC 0555-0211-10
Hospital Charge Code	1710200
Hospital Revenue Code	259
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.34
Rate for Payer: Aetna of CA Government/Medicare	$1.34
Rate for Payer: Cash Price	$1.00
Rate for Payer: Health Smart Auto/Commercial	$1.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.34
Rate for Payer: LLUH Dept of Risk Management WC	$1.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.67

NORETHINDRONE ACETATE 5 MG TABLET [10747]

Facility

$0.72

Service Code	NDC 68462-304-50
Hospital Charge Code	1710200
Hospital Revenue Code	259
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.43
Rate for Payer: Aetna of CA Government/Medicare	$0.43
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.43
Rate for Payer: LLUH Dept of Risk Management WC	$0.40
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.54

Know your out-of-pocket cost for care.

All Charges